title: Measuring frailty in heart failure: a community perspective.
abstract: BACKGROUND
  Frailty, an important prognostic indicator in heart failure (HF), may be defined as a biological phenotype or an accumulation of deficits. Each method has strengths and limitations, but their utility has never been evaluated in the same community HF cohort.
  
  
  METHODS
  Southeastern Minnesota residents with HF were recruited from 2007 to 2011. Frailty according to the biological phenotype was defined as 3 or more of: weak grip strength, physical exhaustion, slowness, low activity and unintentional weight loss >10 lb in 1 year. Intermediate frailty was defined as 1 to 2. The deficit index was defined as the proportion of deficits present out of 32 deficits.
  
  
  RESULTS
  Among 223 patients (mean age 71 ± 14, 61% male), 21% were frail and 48% intermediate frail according to the biological phenotype. The deficit index ranged from 0.02-0.75, with a mean (SD) of 0.25 (0.13). Over a mean follow-up of 2.4 years, 63 patients died. After adjustment for age, sex and ejection fraction, patients categorized as frail by the biological phenotype had a 2-fold increased risk of death compared to those with no frailty, whereas a 0.1 unit increase in the deficit index was associated with a 44% increased risk of death. Both measures predicted death equally (C-statistics: 0.687 for biological phenotype and 0.700 for deficit index).
  
  
  CONCLUSIONS
  The deficit index and the biological phenotype equally predict mortality. As the biological phenotype is not routinely assessed clinically, the deficit index, which can be ascertained from medical records, is a feasible alternative to ascertain frailty.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: McNallan
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.forename: Ruoxiang
authors.initials: R
authors.lastname: Jiang
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010641:Phenotype; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies